The applicant was the first to undertake a large-scale case-control study of colorectal adenomas, describing risk factors for their incidence and recurrence. This led to a strong interest in colorectal cancer screening, with Dr. Neugut one of the earliest advocates of the use of colonoscopy for screening. More recently, his interest in large bowel neoplasia has led to research in the epidemiology of small bowel adenocarcinoma; his research has confirmed a similarity between large and small bowel adenocarcinoma in a number of important ways. Dr. Neugut has also had extensive experience in the use of the SEER Registry and other large data bases for studying the epidemiology of multiple primary cancers, including a close association between small bowel and large bowel adenocarcinoma for co-occurrence in the same individuals, and an elevated risk for colorectal cancer with breast cancer in women. He proposes in this Award to expand his activities in health outcomes and health services research. This is an area in which Dr. Neugut has obtained research funding proposing to utilize the linked Medicare-SEER database, to explore various diagnostic and treatment-related issues in colorectal cancer, i.e., the risks of colonoscopy on a population-based scale, variations in the use of adjuvant chemotherapy for stage 111 colorectal cancer, the extent and cost of toxicity associated with the use of chemotherapy for colorectal cancer, etc. This research effort builds on his experience with the use of SEER and his clinical oncology experience. The Award will provide the opportunity to delve more deeply into use of the linked Medicare-SEER database for important epidemiologic, prevention, and cost-effectiveness questions, and will serve as a vehicle for future trainees. To translate cancer prevention and control findings to the community, he has developed expertise in the area of academic detailing, a method of increasing use of cancer prevention and screening tools by educating primary care practitioners regarding new advances in these areas. An American Cancer Society funded study is to randomize 400 primary care physicians, half to the intervention (visits and materials from the detailers), and half not. Knowledge, attitudes and beliefs regarding screening will be measured at baseline and at six months, and random records will be reviewed and audited to determine changes in behavior. This project builds upon Dr. Neugut's expertise in colon cancer epidemiology and screening as well as in academic detailing. He has been the PI of a T32 training grant which is funded for 10 pre- and post-docs yearly, and has been personally responsible for mentoring multiple trainees on every level, many of whom have gone on to academic faculty positions.